Surgical safety checklists: Save lives and cut length of stay

Surgical safety checklists (SSC) can save lives and reduce lengths of stay but only if they are properly implemented in the operating room, according to a new study.

Bolzano Central Hospital, a tertiary care hospital in Italy, closely inspected outcomes of 10,700 patients for the six months before and the six months after SSCs were introduced as part of standard hospital procedure.

The team's results, which were published this week in JAMA Surgery, showed that the implementation of the checklists led to a 27 percent drop in the risk of death within 90 days after surgery, but not within 30 days. The average length of the hospital day dropped from 10.4 days to 9.6 days after the introduction of the checklists, which included 17 to 24 items.

"To our knowledge, this report is the first on the association of SSCs and 90-day all-cause mortality, which might be even more important than 30-day all-cause mortality," wrote study lead author Matthias Bock, M.D., and colleagues.

An accompanying commentary by William Berry, M.D., of the Harvard School of Public Health, and colleagues, said that the evidence of improved patient outcomes and quality of care indicates that the checklists should become standard in operating rooms and surgical centers.

The main problem, Berry acknowledged, comes with the difficulty of implementing these systems consistently.

"A focus on the systems of care and promotion of a culture of safety at the institutional level is necessary to optimize checklist implementation and realize its full potential. Effective implementation is critical to meaningful use of SSCs, which can lead to maximally improved outcomes," he wrote.

An array of evidence points to the effectiveness of SSCs at reducing mortality and complications. But a study conducted in 2015 supports Berry's contention, noting that SSCs will have no effect on patient outcomes unless they are consistently implemented with the support of hospital leadership and an equal buy-in from the surgical and hospital staff.

"The clear lesson for hospital leaders is that they cannot just dump a stack of checklists in an operating room--they must observe them being used," said the 2015 report. "Are team members all present? Are they rushing, or skipping steps? If so, then the lapses should be discussed and addressed,"